Labor Preparation

Recommendations and information provided by Fairfax OB-GYN Associates

Perineal Massage

The perineum is the tissue between the vagina and the anus. Research suggests that perineal massage done prior to labor may help protect the perineum from tearing at birth. If you are interested, you can start between 34 and 36 weeks and perform the massage once or twice a week. Learning to breathe and relax the pelvic floor muscles when you experience a stretching sensation prepares you to do the same when the baby’s head is crowning. The following non-medical website has reasonable directions: Perineal Massage

Water-soluble lubricants like KY Jelly are fine to substitute for oils.

Evening Primrose Oil

This herbal supplement has been shown to soften the cervix at full term. We may suggest taking Evening Primrose Oil if you are having your first baby, if there is a need for induction, or if you had a prior cesarean without your cervix dilating.

Look for Evening Primrose Oil, 500 mg softgels, at stores selling dietary supplements. Take one capsule up to three times per day, with meals, starting at 38 weeks.

If your bag of water is intact and you are not having vaginal bleeding, you can also place one Evening Primrose Oil softgel deep in the vagina at night to work directly on the cervix while you sleep. (The gel coating will melt, so be prepared for some of the oil to drip out.)

False Labor or True Labor

Some normal physical changes are not labor at all.

Mucous Plug. You may notice an increase in vaginal discharge that is yellow or brown. (It may also be red or pink, especially after a vaginal exam.) It is not necessary to call the office if this occurs. The body can replace lost mucus, so women can pass their “mucous plug” more than once. You can discuss it at your next appointment.

Lightening. This is the process where the baby begins to settle in the pelvis to prepare for delivery. It will cause an increase in pressure in the pelvic area and it may cause more frequent urination.

KEY POINT: If you are trying to figure out if you are in labor, the single most important thing might be to get some REST to be ready for whatever comes next. Labor got its name with good reason! (Eating a snack, drinking plenty of fluids, perhaps taking a walk or a relaxing shower, may also be wise.)

The definition of true labor is progressive dilation of the cervix. Without a cervix check, how do we judge labor? It can be difficult, even for us, to determine if contractions are the “real thing” or only Braxton Hicks, or preliminary, contractions.

Here are some hints:

False Labor Contractions may be irregular in how often they are and how intense they are.

Contractions do not get closer together over time.

Contractions may be short, less than 40 seconds.

If contractions are long, they may be mild, so that you can still talk during them.

Walking either has no effect on the contractions or it lessens them.

Contractions don’t seem to have a pattern of building in intensity.

True Labor Contractions usually occur at regular and frequent intervals.

The time between contractions generally shortens as time passes.

Walking does not lessen the intensity of contractions.

Contractions have a pattern of getting stronger (and often longer) over time.

Your breathing may become heavy, as if you were exercising.

Nausea, vomiting, or diarrhea may occur.

You may rupture your bag of water. Fluid continues to leak out once the bag is broken.

Labor can take MANY hours, so distraction (movies, etc.) can be good in the early stages and relaxation techniques can be helpful to deal with the pain later on. Strong contractions generally take one’s complete attention just to breathe through them. See “Labor Instructions” about when to call.

Labor Instructions

Call Fairfax OB-GYN Associates, (703) 391-1500 if you believe you are in true labor:

If your bag of water breaks, even if you are not having contractions, please call us. You may experience a big gush of fluid or a continuous leakage of fluid.

If you are contracting, start timing your contractions. Record how far apart they are (from the beginning of one to the beginning of the next) and how long they last (from the beginning to the end of each contraction).

Alternatively, there are phone apps for contraction timing such as Apple’s “Full Term”.

When contractions have been 5 minutes apart or closer and lasting 60 seconds or longer for at least an hour, please call us.

NOTE: If you have given birth before and experienced a quick labor, please inform the doctor or midwife on call.

After hours, select the prompt for an emergency to be connected to our answering service. They will contact either the doctor or midwife on call, so if you want the midwife to come please tell them you are a midwife patient. Be sure to keep your line open for a return call. If you don’t hear back in 15 minutes, call again.

It is important to talk to the physician or midwife on call before you make the trip to the hospital.

EXCEPTION: If you are experiencing a serious complication such as bright red, heavy vaginal bleeding like a period, then just call, give your information, and go directly to the hospital.

Managing Back Labor

Many women experience low back pain with contractions during labor. Lingering pain between contractions, while less common, can also occur.

There are two aspects to managing back pain during labor:

Trying to get the baby to rotate to a more favorable position.

Providing comfort measures for this particular type of pain.

A possible cause of significant back pain is a baby’s less-than-ideal position, usually “Occiput Posterior” (OP, for short). This means that the back of the baby’s head is toward the mother’s back. The problem with this orientation is that the baby’s head does not easily settle deeply into the mother’s pelvis nor smoothly navigate the turn under the mother’s pubic bone.

Fortunately, maternal positions to ease back pain can also make it easier for a baby to rotate into an ideal position.

Hands and Knees

This position provides immediate help for low back pain and lets gravity help a baby to turn, if needed. It has the additional benefit of being THE BEST maternal position for good blood flow to the placenta, bringing lots of oxygen to baby.

Gentle, rhythmic pelvic rocks or side-to-side swaying of the hips might help, too. A variation is to rest your chest on an exercise ball, so that your wrists don’t have to support your upper body. If desired, you can roll the ball back and forth slightly, creating a gentle movement.

Counter Pressure

Having a labor support person apply pressure with their hands to your lower back during contractions can ease some of the pain. You will need to guide them as to how much pressure feels right and just where they need to push. Two tennis balls in a sock with a knot in the top can be a handy tool to massage and to apply counter pressure at the same time. (The sock just keeps the balls from rolling off the bed and bouncing around the room!) A warm or cold pack being pressed against the sore area may feel good. Helpers can reach your back easily when you are on hands and knees.

Warm Water

Getting in a tub can provide buoyancy to a pregnant belly that is soothing for a sore back. If only a shower is available, you can get on hands and knees (with folded towels to cushion the knees) and let the water fall right onto your lower back. Leaning over a birth ball in the shower is another option.

Induction of Labor

Induction means starting labor with physical techniques or medication or a combination of these. Cervical ripening medication may be given as an initial step, if needed. Intravenous pitocin is the most well known method of stimulating contractions. Artificially rupturing the membranes, or “breaking the bag of water”, is common to get contractions more productive.

In a normal, low risk pregnancy, waiting for spontaneous labor is the natural way to allow a woman’s own hormones to determine when labor will start. Medical or prenatal complications, however, may make it safer to induce labor earlier. Your doctor or midwife will review the evidence-based recommendations for your individual circumstances. We want you to be involved in developing the safest plan of care for you.

Elective inductions of labor that are not medically necessary should wait until 39 weeks or later to ensure that baby’s lungs are well developed. Even so, not all elective inductions progress as anticipated. Prenatal visits are an opportunity to thoroughly discuss risks and benefits with your doctor or midwife.